Impact of hypertension on stroke. Are there different age profiles?

Arterial hypertension is the most prevalent modifiable risk factor for stroke. We aim to establish if there is an association between hypertension and type of stroke, and if this varies with age.

Retrospective study of patients with a first stroke discharged from public hospitals in Seville (Spain) between 1999 and 2021. Only patients with hypertension as a risk factor were included. The sample was divided into 3 groups: patients ≤ 50 years, 51 to 79 years and ≥ 80 years.

Of 42 855 strokes, 2141 (4.9%) hypertensive patients with a first stroke, mean age 68 (15) years, and 1010 (47.2%) women, were included. Included were 1274 (59.5%) ischaemic strokes and 867 (40.5%) haemorrhagic strokes, 309 (14.4%) patients ≤ 50 years of age, 1253 (58.3%) patients between 51 and 79 years of age, and 579 (27.3%) patients ≥ 80 years of age. The percentage of patients with a previous diagnosis of hypertension was 24.3% vs 51.3% vs 79.4% (P < .001), with a mean time from diagnosis to stroke of 5.5 (3.7) vs 7.8 (4.9) vs 9.6 (5.1) years (P < .001) respectively. The number of haemorrhagic strokes was: 171 (55.3%), 523 (41.7%), and 172 (29.7%) (P < .001), with mortality at one year being 3.2%, 10%, and 35.6%, respectively (P < .001).

In hypertensive patients with a first stroke, the percentage of haemorrhagic strokes is higher than expected, especially in young patients, where it exceeds half of the cases. It is necessary to optimise prevention in these patients to reduce the enormous social and healthcare burden that stroke represents.